The medical aspects of psychic development and adaptive behavior in children

1. Background of the lecture: The medical aspects of psychic development and adaptive behavior in children.

1. The approaches to the psychomotor assessment in children since
first months until age 6 year inclusively.
2. The semiotics of psychomotor abnormalities in children.
3. The modern theories about psychic development in children.
Approaches to elementary psychological evaluation.
a) The phenomenon of bonding and attachment in young children. An
Isolated child by R.Spitz.
b) Cognitive Theories: Piaget`s, Kohlberg`s
c) Psychoanalytic Theories: Freud`s, Eriksson's
d) Behavioral Theory: Pavlov's, Bandura`s
e) The role of temper in children.

2. The medical aspects of psychic development and adaptive behavior in children.

3.

The persistent dynamic observation of
children for their motor, psychic and
behavioral development is an action directed
on achievement by the individual of the
maximum social health. It is one of the most
important goals in modern pediatrics.

4.

In condition of brain cortex maturation for
period since infancy until preschool age
(before 6 years) the psychic and behavioral
child` development is enough closely
connected with psychomotor development.
So very often the pediatricians at this age
period use the term “psychomotor
development”.

5.

It is necessary to understand that the normal
psychomotor development as the sequence of
appearing in a child since birth until
approximately age 6 years of the motor,
behavioral, emotional and speech skills
(milestones) happens due to participation of
intensively developing nervous system and
particularly brain cortex.

6.

The normal psychomotor development is defined by
making to a child the following necessary optimum
conditions:
- the child must be physically well;
- presence of parents or persons capable to express
toward a child true feeling of attachment ;
- a normal care, feeding and education
- safety of the most important organ feeling: a
vision and a hearing.

7. The approaches to the psychomotor assessment in children since first months until age 6 year inclusively.

8.

The psychomotor development estimations
in young children are executed by means of
out-patient child inspections and
questioning of his or her parents. This
visits are managed usually in fixed dates
corresponding to a date, when a child was
born. Also this dates are called “epicrisial”.
The visits are organizing for the first year of
child life monthly, on 2-3th - quarterly, in
the following - once per year.

9. All behavior skills (milestones) in child should be group up into the following systems which must be tested accurately:

- gross (general) motor, including steady-state skills
(milestones) when a child adapts to gravitation
(to the earth attraction);
- personal-social ("Me and society“)
- language (speech shaping)
- a fine motor milestones (adaptive).
Also the visual and hearing sensation must be
tested.

10. The Ukrainian pediatricians in their everyday clinical practice use the simplified models of motor and psychic age dependant milestones achievement in their average estimations.

11.

Estimating the gross motor skills (milestones) the
following standard sequence of tests is using :
"when did the child begin?..’’
-to keep a head up (set-head steady). The normal
answer is "at age 2 months” (50-th percentile);
-to get sitting (at 6 mo);
-to stand up alone (at 10 mo);
- to walk well (at age 1 year).

12. The fine motor skills (milestones):

- to follow up the objects by eyes (The
visual concentration appears at age
1,5 months);
- to turn over in bed the child begins at 4
months;
- to manipulate with toys (rattles) at 6
mo;
- to rise on stair a child begins since 1,5
years approximately.

13. The establishment of interpersonal-to-society relationships

The establishment of interpersonalto-society relationships
- to smile spontaneously at age 1 month;
- to smile contacting with mother at age
3 mo;
- to be scared with strangers (including a
medical stuff) at 7 mo.

14. The language development:

- to talk "ooo/aah” – the dove (pigeon) sounds
vocalization since the age 1 mo;
- to prattle (“soueals” words) at age 6 mo;
- to pronounce a first intelligent words
(“dana/mama”) at 1 yr.
- to speech a first simple sentences at 2 yr.

15. Visual function evaluation in small children

• In newborns the visual function is defined
on the basis of common reaction on light.
• The light exposition in a sleeping child
makes his eyes more closed. In a small baby
with opened eyes the sudden light provokes
blinking and avoiding reaction.
• The children older 2 months of age can
follow the flashlight by eyes if it is situated
on distance of 30 cm.

16. Auditory function evaluation in small children

• The response to the loud sound can be seen
as the sudden horizontal twitching of eyes
(so called horizontal nistagmus), and
coordinated pupil`s narrowing followed by
their expansion.
• Children older 2 months demonstrate the
response to palms pat on distance of 30-40
cm from the head with blinking or eyes close.
• Since 3 months of age children begin to turn
the head towards the sound of toy which they
do not see.

17. Denver-II-test

• The most accurate test system is
presented in worldwide used Denver-II-test.
The Test is given in a manner of table,
where on horizontal axis is noted an age
sequence in dais, months and years (until
6). On vertical axis the list of child
behavioral acts from the most primitive until
more complexes (on above presented
system) is brought in sequence: gross
motor, language, fine motor - adaptive
and personal – social.

18.

19.

The obtained ones upon a time milestone then
should be stored all the human life.

20. 6 yr aged children have to pass developmental test on school maturity

• The test is executed by school teachers or
school psychologists and detects an
intellectual level (IQ), a level of hand
(manual) abilities to write and to draw, to
copy etc. As a practice the examiners ask a
child to draw liberally a figure of person
which must have schematically all 6 main
human components (head, hands, legs etc).

21.

Copy of “A”
Human figure

22. The semiotics of psychomotor abnormalities in children.

23. Common delay of psychomotor development

The backlog (retardation) on shaping of
all 4 components following gross and fine
motor, personal-social and language
milestones characterizes the common delay
of psychomotor development. It happens in
young children with severe innate or
hereditary CNS diseases or gained after
ischemic-hypoxic injury of brain in labor.

24. The motor developmental delay

• The delay only in motor development
is specific for spinal motor neurons
damage like Werdnig-Goffmann
disease or motor brain cortical neurons
like cerebral palsy.

25. The personal-social and language developmental delay

• The abnormalities of personal-social and
language development are accompanied
with communicative abnormalities or
pathology of interpersonal contacts
establishment. They are typical off innate
deafness, blindness, autism. Affected
children avoid any dill with children and
adults. The feeble-mindedness
(olygophreny) also leads to communicative
problems.

26.

There are several easy approaches in
diagnostics of the abnormalities in sphere of
interpersonal contacts in childhood.
In infants aged 1-12 mo very alarm symptoms
are the following:
- a child aged before 6 mo does not scare, blink or change
immediately its activities in response to sudden loud sound;
- a child aged before 6 mo is not interesting by human
speech, does not quiet down in response to mother voice;
- a child aged before 6 mo. does not pronounce “ooo/aah”
and prattle;
- a child aged before 10 mo. does not react on his or her
name;
- a child aged before 12 mo. pronounces only sounds which
are limited only by wail, moan or long vowels.

27.

There are several easy approaches in
diagnostics of the abnormalities in sphere of
interpersonal contacts in childhood.
In infants aged 1 -3 yr the attention must
attract the following symptoms:
- If the child aged before 18 mo (1,5 yr.) does not
use as minimum as 6 comprehensible words.
- If at age 24 mo. a child does not use two – three
words sentences like: "That is this?", "No need!"
etc..
- If the parents do understand only half from that
their 2 year old child speaks.
- If the 3 yr old child speech is not understandable
for people excluding the parents.

28.

The modern theories about
psychic development in children.
Approaches to elementary
psychological examination.

29.

To understand a human person!
The temper
Cognition
Ethics
Ego
Sociality
Sexuality
Behavior

30. The phenomenon of bonding and attachment in young children.

The process of normal social development can not be
understood without this important psychic phenomenon
appearing in families of early young children.
The bonding (Tie) usually appears immediately after
birth and reflects the positive feeling of the parents toward
the newborn. This fillings are unidirectional.
The attachment involves reciprocal feelings between
parents and infant and develops gradually within the first
year. The effective bonding in the postpartum (post delivery)
period may enhance the development of attachment. The
medical staff has to help the bonding and attachment
shaping providing early nursing with skin to skin mother-tochild contact and the father presence in delivery room. In
these condition the bonding of the parents to child is
formed early and more intensively.

31.

Between 9 and 18 mo, most children become unable
to be separated with their caregivers. It is so called
event “Mommy gets her coat”.

32. Isolated child

The hospitalism is a synonym of
condition then the small child long
time should be separated from the
mother. In this conditions a psychic
distress as an emotional dullness
can occur in child because the
parent-child attachment is broken. In
advanced cases the delay of
psychic development is formed
progressively in affected children.
Some times this condition leads to
the real danger for health and even
for child life.
R. Spitz
(1887 – 1974)

33.

Cognitive Theories

34.

The childhood is a permanent cognition. The
cognition is defined as a process of
knowledge acquisition in broad sense
beginning with perception, continued by
memorizing, judgment and reasoning.

35. The Piaget`s Theory of cognition.

The famous Swiss
psychologist Jan
Piaget (1896 – 1980)
Studying the developmental
psychology of intellect Jan
Piaget contended that the
development of cognitive
abilities occurs in the fixed
strict sequence of
qualitatively different stages.
That way the child`s mind
works in different ways in
each stage.

36. The stages of cognitive development

1. Sensorimotor stage
Jan Piaget
• It is typical of children since birth to 2 years old. The
mastering of the world is realizing through motor activity,
explorations, tests and manipulations of the environment
(external encirclement). Motor and sensitive impressions
create the base for the next stages.
On this stage child learns:
- to differentiate self from world thereby the sense of selfidentity begins to form;
- that action gives result (e.g. that the sucking on a nipple
produces milk or that shaking a rattle produces a noise,
thereby the important schemes of the world form;
- that things exist even when are not visible.

37. The stages of cognitive development

.
The stages of cognitive
development
Jan Piaget
2 Preoperational stage (the age from 2 to 6
or 7 years).
- The child is capable to present the world in
symbolic image in the manner of plays, different
imitation, is capable to present "something" in the
manner of "something else”. ("Mami, tell me about
the pilot in fly, which now was killed“).
- The experimentations with language ("The baby
“burn” or “born”, and etc.).
- Many children in this period decline
egocentricity behavior as a not constructive.
- The child develops language and drawing that
become a models of representing experience.

38. The stages of cognitive development

Jan Piaget
.
3 Concrete operation`s stage (age from 7
to 12 years).
- The child becomes capable logically to
anticipate the process by means of
searching for the intercoupling and
categorization and still by means of
manipulation with objects if they turn out to
be available.

39. The stages of cognitive development

Jan Piaget
.
4 The formal operation`s stage (since 12
years including adults).
- The teenager becomes capable to think
logically and abstractly, to formulate and to
check up mentally hypothesizes, to
manipulate with probability (to calculate the
chances), to construct analogies,
metaphors, to speculate about own thinking
process.

40.

Moral principals development
L. Kohlberg
(1927 – 1987)
Early stage: Toddlers and preschool
children unconditionally take the
authority and adult moral code. They
consider if an action leads to
punishment that it is bad. So the
Choice between wrong and write
children often do in context of their
self-profit.
Midle level: Children consider that
public rules define acceptable or
unacceptable behaviour.
Advanced level. The notion about
correct and wrong are founded on the
personal understanding of the
universal ethical principles. Often they
may be abstract, but usually comprise
the principal of life` conservation at
any cost.

41.

Psychoanalytic Theories

42.

Sigmund Freud (1856-1939) is a greatest
austrian psychiatrist and scientistpsychologist for the first time in the
human history researched person
sexuality from instinctive, social and
subconscious-individual psychic
positions. Freud designed important
principles having big importance for
understanding how it is realizing in
person the most strong gender instinct
(the human instinct of gender
continuation). Also his theory contains a
number of concepts helpful in
understanding of child development.
The Freudian theory of children`s sexual
development.

43.

Freudian pleasure principle it is a theoretic position
according to which the base of a person`s activity since
infancy is a drive to achieve the pleasure and to avoid
displeasure.
Freudian realities principle is a theoretic position according
to which the person behavior directed on desires
satisfaction is correcting permanently by surrounding human
society in accordance with its requirements.
The concept of innate sexual and aggressive drives that
provide “psychic energy” or “libido” also is central to
Freudian theory. The theory in whole interprets the human
psychic as a mastery of unconscious sexual inclinations to
pleasure, which masquerading get into consciousness and in
some situations threatens to the individual psychic stability
and unity, in determined measure defines shaping of
individual personality, behavior, social attitude, becomes a
reason of psychic diseases.

44.

Freud proposed five stages of psychosexual
development at different ages. In them he
focuses on different parts of the body serving
for gratification of drive to get a pleasure

45.

S.Freud
• I. The age 0 - 18 mo. – an oral stage. The Infants obtain
gratification through the stimulation of the mouth as they
suck a breast.
• II. The age 18мo – 3yr - an anal stage – Children obtain
gratification (a pleasure) through exercise the anal
musculature during elimination or retention. It means that
children exercise to restrain or pass stools by volitional
effort and are supported by the mother if they are succesfull
• III. The age 3-6 years - a phallic stage (or the stage of Oedip
complex shaping). In this stage it is absolutely normal if the
children develop sexual curiosity. They have sexual
fantasies about the parent of the opposite sex and feel guilt
about their fantasies.
• IV. The age 6-12 years - a latency stage. – Children`s sexua
urges are submerged. They put their energies into acquiring
cultural skills and are occupied with the common social
knowledge acquisition.
• V. The age from nearly 12 years until adultness – the
genital stage. The teenagers gradually form adult
heterosexual desires and seek to satisfy them (search for
reciprocity).

46.

The Freudian genius has found the roots
of adult psychic problems in infancy.
Are you a heavy smoker?

47. The Eriksson's stages psychosocial development

In his own 8 principles of human
psychosocial the well known
American psychologist Erik Erikson
(1902 - 1994), the Freud`s follower
has developed Freudian theory.

48.

According to Eriksson in its psychosocial development the
person overcomes 8 contradictions.
• 1. In early infantile period (from birth to 18 mo) the stage can be
called as “a confidence against mistrust or trust versus mistrust”. The
infants learn to trust or not trust that their needs will be meet by the
world, especially by mother. They believe to get all they want from
surrounded adults and in the first place from the mother. But the real
world sometimes does not confirm their believes. It produces a
distrusting.
• 2. The late infancy or Toddler hood (from 18мo - 3 yrs) – It is the
stage of independence against shame or autonomy versus shame,
doubt. In this stage the children learn to exercise will, to make choices,
to control themselves, or they become uncertain and doubt that they
can do things by themselves.
• 3.
The Early Childhood (3-6 years) - an initiative against blame or
initiative versus guilt. The children at this age become capable to
learn, to initiate activities and they enjoy their accomplishments. In
ditto time they see that there are many purposes that they can not
reach. It causes them the feelings of insecurity, shame, guilt.
• 4. Middle childhood or Elementary school (6-12 yrs) age - an
industry (zeal, zealousness) versus inferiority. The children learn to do
things well. They develop drives of zeal and curiosity and want to
learn. In opposite event the unwillingness to execute the lessons in
general develops.

49.

E.Eriksson
5.
Adolescence or teens age (12-21 years) – Identity vs.
Role Confusion. The teenagers consider thamselfs as unique
individuals but at the same time typicaly they unite in
companies on alike interest principles. In opposite event the
role confusion can appear whan the person starts to feel
embarrassment from the personal waiting as much he or she
wants to get from life.
6.
Young adults –Initimacy vs. Isolation.
7.
Mature age (Middle Adulthood) - Generativity vs.
Stagnation or personal activity against inaction. The person
Develops interest in guiding the development of the next
generation.
8.
The elderly age (Elder Adulthood) - Ego Integrity vs.
Despair or a holistic perception of the world against despair.
The person develops a sense of acceptance of life as it was
lived over the lifespan.

50.

Behavioral Theory

51. The Behavioral theory.

• The Behavioral theory in principal differs from the
cognitive theory and concerns of the person
adaptive behavior shaping.
• Its main principle states that the person behavior
is a product of external environmental
determinants. The manipulation with the
environment can be useful in modification of
maladaptive behavior and in increasing of
desirable behavior acts. The learning is
considered terminated if a conditionally-reflexrelationships appear. In learning the people do not
differ from the animals.

52.

The adaptative learning
was demonstrated in the
famous Pavlov's experiment
with a dog, its gastric
secretion, food and bell
when the repeatedly
reiterative sound begins to
play for a dog a signal to the
dinner.
The great physiologist,
laureate (1904) of Nobel
prize in medicine,
academician Ivan Pavlov
(1849-1936).

53. 4 main learning methods for creation of conditionally-reflex-relationships in children are selected:

1. Positive reinforcement. It means that the desirable
behavioral acts become more frequent because after that
they follow the pleasing sensation (for instance, child eats
vegetables, because after that he will get the sweets);
2. Negative reinforcement. The behavioral acts become less
frequent because allow to avoid the unpleasant sensations
("The parental anger will drop if I hold myself a little farther
from gas plate" );
3. Extinction or fading occurs when behavioral acts worked
out by positive or negative reinforcement methods become
rare because they are not supported by reception of
expected sensations (for instance, the reasonable advice to
ignore the crying of growing infant at bedtime which the
parents can intensify by their attention and making a comfort
if they put a child in their bed like before);
4. Punishment. This is an exclusive form of learning when
the maladaptive behavior must be stopped immediately by
severally unpleasant consequence.

54.

Probably this severe electric trouma could be
avoided if child`s actions were stopped by any adult.

55. The punishment in children

• The most acceptable punishment by
misdeed is “A time out” (respite) . The
child has to stay within certain time
(approximately 1-2 min. per year of age)
without occupation in solitude indoors
(only not in his bedroom) without
television set, music etc.

56. The conditions related with learning mistakes.

• Often the behavioural deviations (so
called marginal behaviour) develop as a
consequences of gained undesirable
conditionally-reflex-relationships. They
are capable to create the certain
problems for the child and his parents
(fears, stutter, fobias founded on
painful waiting etc.).

57. Child abuse syndrome

The child abuse syndrome means the
physical violence directed on the child from
the side of adult person. Usually it is an
intentional damage which some adults
regard as a punishment. This violence may
be dangerous for health and even for child
life. It is known that 50% of children which
suffer from violence repeatedly are
subjected to abuse from their relatives and
adopters. Most of this children have
repeated attacks of violence and 5% of
them perish.

58.

А.
В.
С.
А. Hand mark on the buttocks of a 6-month-old infant. The
impact of a hand results in an outline of the fingers rather
than a silhouette.
В. Marks from impact with a coathanger. A coathanger, wire,
or electric cord causes contusions and lacerations. An
electric cord leaves a narrower-diameter loop mark.
С. Impact from belt buckle.

59.

60.

Rib fractures. Old and new fractures of the right rib cage in a 9month-old infant. Certain fractures are more suggestive of
intentional rather than accidental injuries. These include rib
scapular and metaphyseal fractures and spinal fractures in
preambulating children.

61. The children widely differ in their behavior

• Defining a child as bordered (or marginal)
in his or her behavior it is enough to make
a judgment: is this behavior act (for
instance, chronic vagrancy) adaptive or not.
This judgment must be based on analysis of
external environments led the child to action
in context with his physical, intellectual and
social individual conditions.

62. Children widely differ in their behaviour.

• Albert Bandura (born 1925) in his
experiment “Bobo doll” has
showed that the actions of
children also can be explained
by the following to the adult
behavioural modeles.

63.

The children widely differ in their
behavior. The role of temper.

64. The children widely differ in their behavior. The behavioral style depends on temper.

1. “Easy" children (40% in population) are characterized by
regularity of biological functions. There are a constant,
regular mealtime and stable bedtime. For children of this
group are typical the positive reactions to new and constant
positive mood. (Sanguine)
2. "Difficult" children (10% in population) differ from others by
irregularity of physiological functions, by negative reactions to
new and avoiding of new stimulus and mainly negative
background of the mood. Typically they are a melancholic
persons.
3. "Slow" children (15% in population) are characterized by low
level of activities, by usual desire to escape from new
impressions and as a whole by gloomy (non-fun) background
of the mood. (They are a group of phlegmatic).
4. The rest of children pertains to the mixed behavioral group.

65. The behavioral features in teenagers.

The motives forming behavior are
different within the following periods:
• - early teens ( children 10-12 year old);
• - average teens (12-14 year);
• - late teens (14 - 21 year).

66. The early teenagers period

• During the early teens period the child is
characterized by maximum somatic growing
and shaping his (her) secondary sexual
signs. The thoughts of teenager are
concentrated on the present and on
members of peer group. Attention is fixed in
the first place on physical and appearance
body changes and their normalcy. The
independence strive conflicts with the
rudiments of "parenteral attachment".

67. The average teens period

The average teens period can be the most difficult
and problematic as for teenager as for his or her
parents. The cognitive abilities become more
constructive. From a formal operating by notions
the teenager goes to operate with ideas
considering things in their ideal sense. The young
person searches for acknowledgement in others
people. The significant importance for teenagers
at this period is to confirm their identity with
other peers. Often the teenager falls into a group
of other teenagers and can accept the high risky
life style spending a lot of time abroad of home.

68. The high risky behavior in teenagers in typical events is:

- undesirable pregnancy;
- drugs addiction;
- motorcycle's and other accidents.

69. Late teenagers

Late teenagers develop an abstract thinking
including cogitations about future (about
education, job, love and marriage). The
unsolved alerts in respect of their own
independence can be shown that the young
persons begin physically and practically move
from families in area of the educational
institutions, worker groups or military service
divisions. The centrifugal trends in system
"Me, as a young independent person" and "my
parents, which see me a child" win centripetal
ones. The parental attachment turns out for to
be appeared again in new generations.

70.

Спасибо за внимание!
Консультации (и отработки) по
лекционному материалу –
каждый понедельник на второй
академической неделе, кабинет
зав. кафедрой, проф. Иванько
Олега Григорьевича, 2-я детская
клиническая поликлиника, с 15
до 17.